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Physicians set for Medicare pay hike under draft regulation

Physicians set for Medicare pay hike under draft regulation

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Tune in for a crucial breakdown of the latest proposed changes impacting Medicare payments for doctors, new healthcare models, and telehealth services. This episode dives deep into the draft regulation released by the Centers for Medicare and Medicaid Services (CMS), outlining significant updates that could reshape healthcare delivery and access.Here's what you'll learn:• Physician Pay Hike: Discover how doctors are set for a 2.5% increase in the base Medicare rate in 2026, a mandate from the recent "One Big Beautiful Bill". We'll also explain the higher reimbursement boost for doctors participating in alternative payment models, with a conversion factor of 3.83% compared to 3.62% for traditional fee-for-service Medicare. This follows a challenging year for doctors, who saw a 2.9% reduction in Medicare reimbursement.• New Mandatory Payment Models: Unpack the proposed five-year Ambulatory Specialty Model, which would mandate specialists to improve care for heart failure and lower back pain starting in 2027. Learn about this two-sided risk model and how CMS aims to assess quality, costs, and early intervention.• Enhanced Telehealth Flexibilities: Understand how CMS proposes to simplify the process for making additional telehealth services reimbursable under Medicare. Plus, explore new rules allowing physicians to carry out direct supervision for certain services, like cardiac rehabilitation, using audiovisual telecommunications.• Changes to the Shared Savings Program: We'll cover proposed limits on how long certain Medicare Shared Savings Program participants can remain in one-sided risk arrangements, with the goal of increasing participation in two-sided risk arrangements. Accountable Care Organisations (ACOs) are also set to gain some relief from the requirement to cover at least 5,000 Medicare beneficiaries, with a new three-year window to achieve this benchmark from 2027.• CMS's Vision: Hear directly from CMS Administrator Dr. Mehmet Oz on the agency's goals: "We’re making it easier for seniors to access preventive services, incentivising healthcare providers to deliver real results and cracking down on abuse that drives up costs".This insightful discussion highlights CMS's ongoing efforts to tackle chronic illness and prevention, and its deregulation agenda, with a crucial deadline for public comments set for 12 September. Stay informed on these vital changes affecting healthcare providers and beneficiaries across the nation.

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